Litigation & Enforcement

Impact on the Legal Landscape

NHeLP’s litigation team appears as counsel in federal and state courts across the country, shaping the legal landscape of the Medicaid Act, as well as constitutional and statutory due process, disability rights, access to the courts, and other topics. Our work has extensive impact. NHeLP’s litigation team routinely provides extensive technical assistance in cases in which we are not counsel but have significant expertise. Some highlights from our history include:

• Medicaid rights of enrollees are enforceable. Litigation involving the enforceability of the Medicaid Act consistently cites NHeLP cases from across the country and NHeLP amicus briefs to confirm that rights to coverage or services are enforceable in court.  
• Medicaid-enrolled children have broad rights to well-child check-ups and all services needed to treat their conditions, ensuring they receive the services needed to avoid preventable conditions. NHeLP has been involved in most of the litigation that has enforced children’s right to early and periodic screening and treatment services over the years. NHeLP’s work has improved the availability of a range of services, from oral health to in-home nursing care. NHeLP’s work with the NAACP-LDF and NRDC established that Medicaid-enrolled children must be screened for exposure to lead—an environmental hazard that has irreversible consequences on a child’s development—so that exposed children receive appropriate intervention and treatment.
• Community-based mental health services are provided to Medicaid-eligible children. NHeLP’s litigation on behalf of children with mental health conditions under the Medicaid Act, the ADA, and the Rehabilitation Act has expanded Medicaid coverage of intensive home and community-based services for children across the country. Over the past two decades, NHeLP has worked to ensure that children, including those in foster care, receive the necessary array of mental health services in the most integrated setting. These cases often transform patchwork, inaccessible systems that rely on children’s unnecessary institutionalization into coordinated care systems with key services for children with mental health needs.
• People with disabilities have the right to live in their communities, and that right includes avoiding the risk of living in institutions and other restrictive settings. NHeLP’s cases established the right to community living in several federal circuits and are frequently cited for courts’ recognition that a person may not be placed at risk of unnecessarily moving from their homes to institutional settings. NHeLP has a long history of successful litigation to prevent service cuts that jeopardize community placements and threaten unnecessary institutionalization.
• Due process in Medicaid adheres to all the principles set forth in Goldberg v. Kelly. Notice to enrollees and the opportunity for them to be heard cannot be shortchanged for the convenience of states, managed care programs, or providers. NHeLP’s legal theories and litigation have been foundational in forcing agency transparency and accountability, regardless of the basis for the agency’s decision and whether it was made using algorithms, matrices, or documents over which entities assert intellectual property rights.
• The state Medicaid agency is the responsible party. Despite states’ broad delegation of responsibilities to managed care plans, providers, and other contractors, NHeLP’s litigation holds states accountable for satisfying their obligations to Medicaid applicants and enrollees. For decades, NHeLP has been a leader in ensuring managed care does not erode beneficiary rights in Medicaid. We have challenged service cuts and due process failures in states with managed care and leveraged our longstanding familiarity with beneficiaries’ experiences to influence regulations, policies, contracting, and monitoring for Medicaid managed care. 
• Eligibility restrictions beyond what the Medicaid Act permits, such as mandatory work requirements and premiums for very low-income populations, are not allowed. NHeLP’s Litigation & Enforcement team has led the development of the body of administrative law regarding the limits of government authority to use Medicaid demonstration projects under Section 1115 to enforce deep coverage cuts. For example, this litigation has stopped harmful work requirements in Arkansas, Kentucky, New Hampshire, and other states.
• Advocacy to ensure that access to reproductive health care is not illegally restricted. From filing to enforcing equal access to the full range of care services and providers, NHeLP has litigated and filed amicus briefs throughout its history to protect access to critical sexual and reproductive health services, including abortion.
• The Affordable Care Act continues to protect access to health care for millions, with protections against non-discrimination. Although many have fought to save the ACA, NHeLP has been an ardent, ongoing amicus party filing brief after brief to influence the courts. Justice Ginsberg cited NHeLP’s amicus brief in her concurring opinion in NFIB v. Sebelius, the Supreme Court case that upheld most of the provisions of the ACA. NHeLP’s enforcement work has significantly contributed to the shaping of Section 1557 of the ACA through successful administrative complaints regarding discriminatory drug tiering for HIV/AIDS treatment, amicus briefs, and intensive technical assistance. NHeLP’s work on equal access to HIV/AIDS treatment is part of a long tradition for the organization regarding fairness in access to prescription drugs, including pricing transparency.
• Language access must be provided in health care. From its early days, NHeLP’s enforcement efforts included work to ensure language access. NHeLP’s administrative complaints and other enforcement work have ensured that people with limited English proficiency can access the language services and care they need. NHeLP’s work includes a settlement that became the framework for the Department of Health & Human Services language access policy and later the federal government-wide language access policy. 
• People with disabilities have equal access to Medicaid programs. Many of NHeLP’s cases fight not only for access to needed services but also for non-discriminatory access to services or coverage in general. Too often, states design and operate their programs in a manner that screens out eligible people with disabilities. Whether these result from flawed system design or administrative failures, NHeLP’s litigation has enforced the right to non-discriminatory care.